ATI MEDICAL-SURGICAL RESPIRATORY EXAM
300 QUESTIONS
Q&A
1. A nurse is assessing a client with pneumonia. Which finding is the earliest indicator of hypoxemia?
A. Cyanosis
B. Restlessness
C. Clubbing of fingers
D. Bradypnea
Rationale: Restlessness and confusion are early signs of hypoxemia due to cerebral hypoxia. Cyanosis is
a late finding. Clubbing indicates chronic hypoxemia. Bradypnea typically occurs in severe, late
respiratory depression.
2. A client with COPD has an SpO₂ of 86% on room air. What should the nurse do first?
A. Apply oxygen at 2 L/min via nasal cannula
B. Prepare for intubation
C. Place the client in Trendelenburg position
D. Administer a bronchodilator
Rationale: First action is to correct hypoxemia with low-flow oxygen. COPD patients rely on hypoxic
drive, so high oxygen can cause hypoventilation. Trendelenburg impairs breathing. Bronchodilators are
important but not the first step for low SpO₂.
3. A nurse hears diminished breath sounds at the left lung base. Which action is most appropriate?
A. Document as normal finding
B. Ask the client to cough and auscultate again
C. Increase oxygen flow rate
D. Prepare for chest tube insertion
Rationale: Coughing may clear secretions and reveal underlying breath sounds. Diminished sounds can
be from mucus plugging or shallow breathing, not always pathology. Chest tube is for
pneumothorax/effusion, not first step.
4. Which assessment finding in a client with asthma indicates impending respiratory failure?
A. Wheezing in all lung fields
B. Silent chest
1
, C. Productive cough with clear sputum
D. Respiratory rate of 20/min
Rationale: Silent chest indicates severe airflow obstruction with no audible air movement—a medical
emergency. Wheezing suggests narrowing but air is still moving. Productive cough and RR 20 are
expected in mild/moderate asthma.
5. A client with a new tracheostomy has bloody secretions. What is the nurse’s priority?
A. Suction aggressively every hour
B. Notify the provider immediately
C. Monitor for 24 hours as this is normal
D. Instill 5 mL saline before suctioning
Rationale: Immediate notification is required if bleeding is significant or increasing. Small blood-tinged
mucus is normal post-op but large amounts indicate hemorrhage. Routine saline instillation is not
recommended.
6. The nurse is caring for a client on mechanical ventilation with a pressure support of 10 cm H₂O. Which
finding indicates the setting is appropriate?
A. Tidal volume 300 mL, RR 30
B. Tidal volume 500 mL, RR 16
C. Client fighting the ventilator
D. Peak pressure 45 cm H₂O
Rationale: Tidal volume 500 mL and RR 16 suggest adequate support without excessive work of
breathing. Low tidal volume/high RR indicates fatigue or inadequate support. Fighting suggests
inappropriate settings.
7. A client with tuberculosis is placed on airborne precautions. Which PPE is essential when entering the
room?
A. Surgical mask
B. N95 respirator
C. Gown and gloves only
D. Eye shield
Rationale: N95 respirator (or PAPR) is required for airborne diseases like TB, measles, varicella. Surgical
masks protect against droplets only. Gown/gloves are for contact precautions.
8. Following a thoracentesis, the nurse should monitor the client for which complication?
A. Pneumothorax
2
, B. Hemorrhage
C. Infection
D. All of the above
Rationale: All are potential complications. Pneumothorax from lung puncture, hemorrhage from
intercostal vessel injury, infection from contamination.
9. A client with pulmonary embolism is on heparin drip. The aPTT is 98 seconds (control 30 sec). What
should the nurse do?
A. Increase the heparin rate
B. Decrease the heparin rate
C. Continue at same rate
D. Stop heparin and give protamine
Rationale: Therapeutic aPTT for PE is 1.5–2.5 × control (45–75 sec). 98 sec is supratherapeutic and
increases bleeding risk. Decrease rate per protocol. Protamine is for severe bleeding.
10. Which arterial blood gas (ABG) result indicates uncompensated respiratory acidosis?
A. pH 7.50, PaCO₂ 30, HCO₃ 24
B. pH 7.30, PaCO₂ 55, HCO₃ 24
C. pH 7.35, PaCO₂ 60, HCO₃ 32
D. pH 7.48, PaCO₂ 48, HCO₃ 30
Rationale: Uncompensated respiratory acidosis: low pH (<7.35), high PaCO₂ (>45), normal HCO₃ (22–26).
Option B fits. Option C is compensated.
11. A nurse is teaching a client with COPD about pursed-lip breathing. What is the primary benefit?
A. Increases oxygen intake
B. Prevents airway collapse during exhalation
C. Strengthens diaphragm
D. Clears mucus from airways
Rationale: Pursed-lip breathing creates back pressure, keeping small airways open during exhalation,
reducing air trapping. It does not directly strengthen diaphragm or clear mucus.
12. Which finding in a client with a chest tube to water seal is most concerning?
A. Tidaling in water seal chamber
B. Constant bubbling in water seal chamber
3
, C. Drainage of 50 mL in 4 hours
D. Client reports pain at insertion site
Rationale: Constant bubbling indicates an air leak. Tidaling is normal with respiration. 50 mL drainage is
minimal. Pain is expected but manageable.
13. A client with lung cancer develops hoarseness. This suggests metastasis to which structure?
A. Brain
B. Recurrent laryngeal nerve
C. Pleura
D. Esophagus
Rationale: Recurrent laryngeal nerve compression causes vocal cord paralysis → hoarseness. Brain mets
cause neuro symptoms. Pleural → effusion. Esophageal → dysphagia.
14. The nurse notes a client’s chest is asymmetrical with absent breath sounds on the right. Trachea
deviates to the left. What is the priority?
A. Administer bronchodilator
B. Prepare for needle decompression
C. Obtain chest X-ray
D. Elevate head of bed
Rationale: Tension pneumothorax: absent breath sounds, tracheal deviation away from affected side.
Needle decompression is life-saving. Chest X-ray delays care.
15. A client on a ventilator has a sudden drop in SpO₂ to 80% and absent breath sounds on the left. The
nurse suspects:
A. Pulmonary embolism
B. Mucous plug
C. Right mainstem intubation
D. Ventilator asynchrony
Rationale: Right mainstem intubation occurs if ETT advanced too far, ventilating only right lung →
absent left breath sounds, desaturation. Reposition tube. PE usually bilateral or sudden without tube
shift.
16. Which medication should the nurse administer first for acute exacerbation of asthma?
A. Oral prednisone
B. Inhaled albuterol
4
300 QUESTIONS
Q&A
1. A nurse is assessing a client with pneumonia. Which finding is the earliest indicator of hypoxemia?
A. Cyanosis
B. Restlessness
C. Clubbing of fingers
D. Bradypnea
Rationale: Restlessness and confusion are early signs of hypoxemia due to cerebral hypoxia. Cyanosis is
a late finding. Clubbing indicates chronic hypoxemia. Bradypnea typically occurs in severe, late
respiratory depression.
2. A client with COPD has an SpO₂ of 86% on room air. What should the nurse do first?
A. Apply oxygen at 2 L/min via nasal cannula
B. Prepare for intubation
C. Place the client in Trendelenburg position
D. Administer a bronchodilator
Rationale: First action is to correct hypoxemia with low-flow oxygen. COPD patients rely on hypoxic
drive, so high oxygen can cause hypoventilation. Trendelenburg impairs breathing. Bronchodilators are
important but not the first step for low SpO₂.
3. A nurse hears diminished breath sounds at the left lung base. Which action is most appropriate?
A. Document as normal finding
B. Ask the client to cough and auscultate again
C. Increase oxygen flow rate
D. Prepare for chest tube insertion
Rationale: Coughing may clear secretions and reveal underlying breath sounds. Diminished sounds can
be from mucus plugging or shallow breathing, not always pathology. Chest tube is for
pneumothorax/effusion, not first step.
4. Which assessment finding in a client with asthma indicates impending respiratory failure?
A. Wheezing in all lung fields
B. Silent chest
1
, C. Productive cough with clear sputum
D. Respiratory rate of 20/min
Rationale: Silent chest indicates severe airflow obstruction with no audible air movement—a medical
emergency. Wheezing suggests narrowing but air is still moving. Productive cough and RR 20 are
expected in mild/moderate asthma.
5. A client with a new tracheostomy has bloody secretions. What is the nurse’s priority?
A. Suction aggressively every hour
B. Notify the provider immediately
C. Monitor for 24 hours as this is normal
D. Instill 5 mL saline before suctioning
Rationale: Immediate notification is required if bleeding is significant or increasing. Small blood-tinged
mucus is normal post-op but large amounts indicate hemorrhage. Routine saline instillation is not
recommended.
6. The nurse is caring for a client on mechanical ventilation with a pressure support of 10 cm H₂O. Which
finding indicates the setting is appropriate?
A. Tidal volume 300 mL, RR 30
B. Tidal volume 500 mL, RR 16
C. Client fighting the ventilator
D. Peak pressure 45 cm H₂O
Rationale: Tidal volume 500 mL and RR 16 suggest adequate support without excessive work of
breathing. Low tidal volume/high RR indicates fatigue or inadequate support. Fighting suggests
inappropriate settings.
7. A client with tuberculosis is placed on airborne precautions. Which PPE is essential when entering the
room?
A. Surgical mask
B. N95 respirator
C. Gown and gloves only
D. Eye shield
Rationale: N95 respirator (or PAPR) is required for airborne diseases like TB, measles, varicella. Surgical
masks protect against droplets only. Gown/gloves are for contact precautions.
8. Following a thoracentesis, the nurse should monitor the client for which complication?
A. Pneumothorax
2
, B. Hemorrhage
C. Infection
D. All of the above
Rationale: All are potential complications. Pneumothorax from lung puncture, hemorrhage from
intercostal vessel injury, infection from contamination.
9. A client with pulmonary embolism is on heparin drip. The aPTT is 98 seconds (control 30 sec). What
should the nurse do?
A. Increase the heparin rate
B. Decrease the heparin rate
C. Continue at same rate
D. Stop heparin and give protamine
Rationale: Therapeutic aPTT for PE is 1.5–2.5 × control (45–75 sec). 98 sec is supratherapeutic and
increases bleeding risk. Decrease rate per protocol. Protamine is for severe bleeding.
10. Which arterial blood gas (ABG) result indicates uncompensated respiratory acidosis?
A. pH 7.50, PaCO₂ 30, HCO₃ 24
B. pH 7.30, PaCO₂ 55, HCO₃ 24
C. pH 7.35, PaCO₂ 60, HCO₃ 32
D. pH 7.48, PaCO₂ 48, HCO₃ 30
Rationale: Uncompensated respiratory acidosis: low pH (<7.35), high PaCO₂ (>45), normal HCO₃ (22–26).
Option B fits. Option C is compensated.
11. A nurse is teaching a client with COPD about pursed-lip breathing. What is the primary benefit?
A. Increases oxygen intake
B. Prevents airway collapse during exhalation
C. Strengthens diaphragm
D. Clears mucus from airways
Rationale: Pursed-lip breathing creates back pressure, keeping small airways open during exhalation,
reducing air trapping. It does not directly strengthen diaphragm or clear mucus.
12. Which finding in a client with a chest tube to water seal is most concerning?
A. Tidaling in water seal chamber
B. Constant bubbling in water seal chamber
3
, C. Drainage of 50 mL in 4 hours
D. Client reports pain at insertion site
Rationale: Constant bubbling indicates an air leak. Tidaling is normal with respiration. 50 mL drainage is
minimal. Pain is expected but manageable.
13. A client with lung cancer develops hoarseness. This suggests metastasis to which structure?
A. Brain
B. Recurrent laryngeal nerve
C. Pleura
D. Esophagus
Rationale: Recurrent laryngeal nerve compression causes vocal cord paralysis → hoarseness. Brain mets
cause neuro symptoms. Pleural → effusion. Esophageal → dysphagia.
14. The nurse notes a client’s chest is asymmetrical with absent breath sounds on the right. Trachea
deviates to the left. What is the priority?
A. Administer bronchodilator
B. Prepare for needle decompression
C. Obtain chest X-ray
D. Elevate head of bed
Rationale: Tension pneumothorax: absent breath sounds, tracheal deviation away from affected side.
Needle decompression is life-saving. Chest X-ray delays care.
15. A client on a ventilator has a sudden drop in SpO₂ to 80% and absent breath sounds on the left. The
nurse suspects:
A. Pulmonary embolism
B. Mucous plug
C. Right mainstem intubation
D. Ventilator asynchrony
Rationale: Right mainstem intubation occurs if ETT advanced too far, ventilating only right lung →
absent left breath sounds, desaturation. Reposition tube. PE usually bilateral or sudden without tube
shift.
16. Which medication should the nurse administer first for acute exacerbation of asthma?
A. Oral prednisone
B. Inhaled albuterol
4
